DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS Nobile et al’s claim of a potential role of daridorexant in increasing suicide risk prompted this discussion.
The letter provides commentary on the recent concerns raised regarding the potential suicide risk associated with the new hypnotic, daridorexant, underlining its significance as a novel insomnia treatment, while explaining the need for more data to fully assess its implications on mental health.
Key Points:
- Insomnia symptoms independently raise suicide risk and major depression, underlining the importance of insomnia treatment.
- Daridorexant is a newly approved pharmacological option for insomnia treatment in Europe and the US
- Daridorexant’s prescription is specifically approved for chronic insomnia and not acute forms.
- The use of daridorexant in patients with a history of suicide attempts or suicidal ideation is similar to that of all approved hypnotics.
- In the clinical trials of daridorexant, a total of four cases of suicidal ideation were reported, equally distributed across treatment groups, including placebo.
Additional Points:
- The basis of Nobile et al’s claim was two references, which were discussed and clarified.
- No causal relationship could be established between daridorexant and the reported suicidal ideation due to significant confounding factors.
- Current evidence from studies points toward the potential antidepressant-like properties of orexin antagonists.
Conclusion:
- More comprehensive data is needed to properly ascertain the possible aggravation of suicide risk and depression associated with daridorexant. Future studies should also focus on the mechanistic interaction between orexin pathways and mental disorders.
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“Currently, it seems that with the orexin system we are opening new complex windows on our understanding of mood and suicide psychopathologies, and DORAs may also potentially open new scenarios in the treatment of psychiatric disorders.”
Laura Palagini, MD, PhD; et al.
Authors of the Commentary
